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The inverted gender pyramid in career progression among GCC physicians: implications for health workforce policy Open PDF
(Frontiers Media SA, 2026-05-22)
Alzayani, Salman
;
Al-Roomi, Khaldoon
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Almarabheh, Amer
;
Hamdi, Ali M.
INTRODUCTION: Gender equity in the health workforce is central to health systems policy and planning. In the Gulf Cooperation Council (GCC) countries, women constitute most of medical graduates, yet their representation at advanced medical career levels is lower than men, reflecting an inverted gender pyramid. Quantitative evidence across GCC countries remains limited. We examined the gender differences in physicians' career progression among medical graduates of a regional medical school serving multiple GCC countries. METHODS: A cross-sectional observational analysis was conducted using a pre-existing dataset of medical graduates from the College of Medicine and Health Sciences at Arabian Gulf University, Bahrain. Eligible records required gender, nationality, career level, and years since graduation. The sample included 685 graduates. Career progression was defined as advanced versus entry or mid-career level. Characteristics were compared by gender in bivariate analysis using chi square tests. In addition, adjusted odds ratios were estimated using multivariable logistic regression. A p < 0.05 was considered statistically significant. RESULTS: Females comprised most of the medical graduates (57.7%). However, male physicians more frequently achieved advanced career levels than their female counterparts (50.3% vs. 43.0%, p = 0.027), with no significant gender differences in career years (p = 0.518). In adjusted logistic regression model, male physicians had higher odds of attaining advanced career progression compared with females (OR 2.253, 95% CI 1.377-3.686, p = 0.001). DISCUSSION: An inverted gender pyramid was apparent, with women overrepresented among medical graduates but underrepresented among advanced medical career levels. The pattern is consistent with growing international evidence of gender inequities in the medical profession. There is an urgent need for health policy action that improves promotion transparency and formalizes leadership pipeline progression.INTRODUCTION: Gender equity in the health workforce is central to health systems policy and planning. In the Gulf Cooperation Council (GCC) countries, women constitute most of medical graduates, yet their representation at advanced medical career levels is lower than men, reflecting an inverted gender pyramid. Quantitative evidence across GCC countries remains limited. We examined the gender differences in physicians' career progression among medical graduates of a regional medical school serving multiple GCC countries. METHODS: A cross-sectional observational analysis was conducted using a pre-existing dataset of medical graduates from the College of Medicine and Health Sciences at Arabian Gulf University, Bahrain. Eligible records required gender, nationality, career level, and years since graduation. The sample included 685 graduates. Career progression was defined as advanced versus entry or mid-career level. Characteristics were compared by gender in bivariate analysis using chi square tests. In addition, adjusted odds ratios were estimated using multivariable logistic regression. A p < 0.05 was considered statistically significant. RESULTS: Females comprised most of the medical graduates (57.7%). However, male physicians more frequently achieved advanced career levels than their female counterparts (50.3% vs. 43.0%, p = 0.027), with no significant gender differences in career years (p = 0.518). In adjusted logistic regression model, male physicians had higher odds of attaining advanced career progression compared with females (OR 2.253, 95% CI 1.377-3.686, p = 0.001). DISCUSSION: An inverted gender pyramid was apparent, with women overrepresented among medical graduates but underrepresented among advanced medical career levels. The pattern is consistent with growing international evidence of gender inequities in the medical profession. There is an urgent need for health policy action that improves promotion transparency and formalizes leadership pipeline progression.
Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis Open PDF
(2021)
Li, Ben
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Jacob-Brassard, Jean
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Dossa, Fahima
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Salata, Konrad
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Kishibe, Teruko
OBJECTIVE: Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020. STUDY SELECTION: All original studies reporting faculty rank stratified by gender worldwide were included. DATA EXTRACTION AND SYNTHESIS: Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models. RESULTS: Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12). CONCLUSIONS: Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists. PROSPERO REGISTRATION NUMBER: CRD42020197414.
Breaking the Gender Gap: A Two-part Observational Study of the Gender Disparity Among Korean Academic Emergency Physicians Open PDF
(2020)
Lee, Mi Jin
;
Kim, ChangHo
OBJECTIVES: Despite greater access to training positions and the presence of more women in emergency medicine, it has remained a men-dominated field. This study aims to identify the key issues causing the gender gap in Korea and establish measures to overcome them. METHODS: Using the annual statistical reports of the National Emergency Medical Center and data published on the Korean Society of Emergency Medicine website, cases that listed the current status and positions of members in its organization and its committees were analyzed. Secondary analysis was conducted using data from the 2015 Korean Society of Emergency Survey that included physicians' demographics, academic ranking, years of experience, clinical work hours, training and board certification, core faculty status, position, and salaries. RESULTS: As of September 2019, women account for only 12.7% of the total number of emergency physicians (EP) in Korea; of 119 chair/ vice-chair academic positions, women represented only 9.2%. Women EP were more often assistant professors and fellowship-trained, with fewer in core faculty. However, they worked the same numbers of clinical hours as their men counterparts. The median annual salary of women EP was less than that of men EP after adjusting for academic hospital rank, clinical hours, and core faculty status. CONCLUSIONS: A gender gap still exists among Korean EP, and women earn less than men regardless of their rank, clinical hours, or training. Future studies should evaluate more data and develop system-wide practices to eliminate gender disparities.
Women Authors in Nuclear Medicine Journals: a Survey from 2014 to 2020 Open PDF
(2022)
Lasnon, C.
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Girault, G.
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Lebtahi, R.
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Ansquer, C.
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Lequesne, J.
Despite the feminization of the medical workforce, women do not have the same career perspectives as men. In nuclear medicine, little information is available on the gender gap regarding prominent author positions of scientific articles. Therefore, the purpose of this study was to evaluate recent trends in the gender distribution of first and last authorship of articles published in nuclear medicine journals. Methods We conducted a bibliometric analysis of first and last author gender of articles published from 2014 to 2020 in 15 nuclear medicine journals. Manuscript title, article type, journal impact factor, date of publication, first and last name and country of provenance of first and last authors were noted. The Gender-API software was used to determine author gender. All statistics were descriptive. Results Women represented 32.8% of first authors and 19.6% of last ones. Female authorship increased from 28.2% (428 of 1518 articles) in 2014 to 35.5% (735 of 2069 articles, relative increase 72%) in 2020 (p<0.001) for first authors and from 15.6% (237 of 1518 articles) in 2014 to 20.5% (424 of 2069 articles, relative increase 79%) in 2020 (p<0.001) for last ones. Parity was forecasted in 2035 for first authors and in 2052 for last ones. Female authorship increased in Europe for first (p=0.014) and last authors (p<0.001), in highranking journals for first (p=0.004) and last authors (p<0.001) and in other journal ranks for last authors (p=0.01). Female first and last authorship rose for original articles (p=0.02 and p=0.01 respectively) and case reports (p<0.001 and p=0.002 respectively). Regarding collaborations, the proportion of articles produced by male first and last authors decreased from 62.2% in 2014 to 52.9% in 2020 in favor of female first and last authors (OR=1.07, p<0.001), male first and female last authors (OR =1.05, p<0.001) and female first and male last authors (OR=1.03, p<0.001). Conclusion Female first and last authorship in nuclear medicine journals increased substantially from 2014 to 2020, in particular in high-ranking journals, in Europe and for original articles and case reports. Male/male collaborations decreased by 10% in favor of all other collaborations. Parity can be foreseen in a few decades. © 2022 Society of Nuclear Medicine Inc.. All rights reserved.
Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis Open PDF
(2021)
Ha, Giang L.
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Lehrer, Eric J.
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Wang, Ming
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Holliday, Emma
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Jagsi, Reshma
Importance: Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes. Objective: To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank. Data Sources: Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used. Study Selection: A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria. Data Extraction and Synthesis: Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies. Main Outcomes and Measures: The primary study outcome was the h-index. Results: The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02). Conclusions and Relevance: In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.
Gender and Authorship in Pediatric Critical Care Randomized Control Trials∗ Open PDF
(2020)
Xu, G.M.
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Zavalkoff, S.
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De Wildt, S.N.
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Duffett, M.
Objectives: To examine the gender distribution of authorship of pediatric critical care randomized control trials. Data Sources: The 415 randomized control trials in pediatric critical care published before 2019. Study Selection: We included all randomized control trials enrolling children in a PICU. We used PICUtrials.net, which uses comprehensive search strategies of multiple databases, to identify published randomized control trials. Data Extraction: We manually extracted the name and profession of each listed author from each publication and classified each author as male or female based on their name. Results: We included 2,146 authors and were able to classify 1,888 (88%) as men or women. Overall, 38% of authors were women, this varied with the authorship position: 37% of first, 38% of middle, and 25% of last authors were women (p < 0.001). The three most common professions were physician (63%), nonclinician (11%), and nurse (6%) - of which 30%, 45%, and 97%, respectively, were women. The percentage of female authorship overall has increased from 28% in 1985-1989 to 39% in 2015-2018 (p for trend = 0.004). There were no significant differences in the characteristics of randomized control trials published with a female first or last author versus those with both male first and last authors with respect to the median number of children randomized (60 vs. 50; p = 0.41), multicentred trials (17% vs. 24%; p = 0.12), trials at low risk of bias (50% vs. 66%; p = 0.26), reporting any funding (55% vs. 51%; p = 0.66), or median number of citations per year (1.5 vs. 2.4; p = 0.09). Conclusions: Although increasing over time, the percentage of researchers publishing pediatric critical care randomized control trials who are women still lags behind the percentage clinicians who are women. Trials that female researchers publish are similar in characteristics and impact as male researchers. Further work should identify barriers to gender diversity and potential solutions in pediatric critical care research. © 2020 Lippincott Williams and Wilkins. All rights reserved.
Towards gender equity in emergency medicine: a position statement from the CAEP Women in Emergency Medicine committee Open PDF
(2021)
Sheppard, Gillian
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Pham, Chau
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Nowacki, Anna
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Bischoff, Taylor
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Snider, Carolyn
As of January 2019, over half of all doctors working in Canada under the age of 40 were women. Despite equal representation in the profession of medicine, women still experience harassment, discrimination, and pay inequity when compared to their male colleagues. Gender discrimination is present at all levels of medical training and negatively impacts women who want to become emergency physicians. The right to gender equity is part of the Canadian Charter of Rights and Freedoms. The World Health Organization states that "gender inequities are socially generated and, therefore, can be changed." CAEP recognizes that gender equity is important to its members and that it intersects with inequities experienced by other minority groups. This position statement from the committee for Women in Emergency Medicine (EM) is intended to support women and those who identify as women who have chosen EM as their career. Furthermore, it is meant to inform and support policy makers as they consider the unique challenges that women face in their pursuit of excellence in EM.
Use of a Coordinated Social Media Strategy to Improve Dissemination of Research and Collect Solutions Related to Workforce Gender Equity. Open PDF
(2019)
Cawcutt, Kelly A.
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Erdahl, Lillian M.
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Englander, Meridith J.
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Radford, Diane M.
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Oxentenko, Amy S.
Background: To increase awareness, search for solutions, and drive change, disparity-related research needs to be strategically disseminated. This study aimed to quantify whether a social media strategy could: (1) amplify dissemination of gender equity-related articles and (2) collect proposed solutions to gender equity issues. Methods: In April 2018, eight published journal articles covering separate gender equity issues were presented in a 1-hour Twitter chat hosted by Physician's Weekly. Metrics data were collected before, during, and after the chat. During the chat, one question related to each article was tweeted at a time. Qualitative data were extracted from responses and evaluated for thematic content. Results: In the 16-hour period during and following the chat, we tallied 1500 tweets from 294 participants and 8.6 million impressions (potential views). The Altmetric Attention Score of each article increased (average, 126.5 points; range, 91-208 points). Within the respective journal, the Altmetric Rank of seven articles improved (range, 3 to ≥19), while the eighth maintained its #1 rank. The one article for which share and download data were available experienced a 729% increase in shares following prechat posts and another 113% bump after the chat, a 1667% increase overall (n = 45-795). Similarly, downloads, and presumably reads, increased 712% following prechat posts and another 47% bump after the chat, a 1093% increase overall (n = 394-4700). We tallied 181 potential solutions to the eight gender equity-related questions. Conclusion: Our results demonstrate that social media can be used strategically to increase the dissemination of research articles and collect solution-focused feedback.
Gender inequality in cum laude distinctions for PhD students Open PDF
(2023)
Bol, Thijs
Resource allocation in academia is highly skewed, and peer evaluation is the main method used to distribute scarce resources. A large literature documents gender inequality in evaluation, and the explanation for this inequality is homophily: male evaluators give more favorable ratings to male candidates. We investigate this by focusing on cum laude distinctions for PhD students in the Netherlands, a distinction that is only awarded to 5 percent of all dissertations and has as its sole goal to distinguish the top from the rest. Using data from over 5000 PhD recipients of a large Dutch university for the period 2011-2021, we find that female PhD students were almost two times less likely to get a cum laude distinction than their male counterparts, even when they had the same doctoral advisor. This gender gap is largest when dissertations are evaluated by all-male committees and decreases as evaluation committees include more female members.
Five Strategies Leaders in Academic Medicine Can Implement Now to Enhance Gender Equity Open PDF
(2023)
Allan, JM
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Brooks, AK
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Crusto, C
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Feld, LD
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Oxentenko, AS
Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.

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